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Treatment of Acute MS Exacerbations

The most common problem that requires hospital admission for patients with MS is a severe exacerbation that requires supportive care and the administration of IV corticosteroids. Sepsis, often from urinary tract infection or pneumonia, is another cause of acute admission. During an acute admission, many patients are more disabled and dependent in activities of daily living (ADL’s) due to the effects of exacerbation, an unfamiliar environment, and the presence of an IV.

During acute exacerbations, patients are given high doses of corticosteroids intravenously. The most common course of treatment is a 3 to 5 day course of intravenous corticosteroids, which may be followed by a gradually tapering dose of an oral corticosteroid such as predisone. Steroids drugs act to decrease acute inflammation in the CNS. Patients often report feeling better when taking steroids, in part due to the mood elevating effect of the drugs. However, there are serious complications associated with the long term or chronic use of steroids, including hypertension, diabetes, osteoporosis, cataracts, and gastric ulceration.

Although the patient with an acute MS relapse may require an in-hospital stay of several days, a patient with complications such as sepsis or pneumonia may require a longer hospital stay and may need rehabilitation to regain his or her full functional potential.